2007 LVM 21 Club Application
Personal Information
Name*
Address*
Email*
LVM Message
Board Name
2005 LVM
Bib Number
Sex
M
F
Phone
Ext
Type of Membership
Legacy Membership
-- $30 ($20 annual dues + $10 back dues) subject to change
General Membership
-- $15 annual dues, subject to change
You may be requested to include a copy of verifiable documentation for the inaugural LVM event. Please read Article IV of the
LVM 21 Club Charter
before submitting this application.
Membership Information Visibility on Club Website
This club provides a list of its members on one or more websites. Please indicate whether or not you want your real name, email address, and state/country of residence to be made available to:
Private
Members Only
Everyone
Real Name
Private
Members Only
Everyone
E-Mail Address
Private
Members Only
Everyone
State/Country of Residence
Mail
Mail completed application, signed waiver form, and check payable to:
LVM 21 Club
11237 E Ramblewood Cir
Mesa AZ 85212
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